Chua J D, Friedenberg W R
Marshfield Clinic, Wis, USA.
Arch Intern Med. 1998 Sep 28;158(17):1929-32. doi: 10.1001/archinte.158.17.1929.
Superwarfarin sodium exposure or poisoning is a growing public health problem. There were 5133 reported cases of superwarfarin exposure and poisoning in 1988 and 13 423 cases in 1995. Cases may be associated with accidental exposure, suicide attempts, or Munchausen syndrome, and may be difficult to diagnose.
Patients from northern Wisconsin with superwarfarin exposure or poisoning were examined at a tertiary referral center in rural Wisconsin to determine what led to their exposure and to review the clinical manifestations, diagnosis, treatment, and prevention of superwarfarin poisoning.
Eleven cases satisfied the criteria for superwarfarin exposure or poisoning. All 7 children included in the study had accidentally ingested superwarfarin, 2 adults had Munchausen syndrome, and 1 teenager and 1 adult had attempted suicide using superwarfarin. Nine of the 11 cases had taken brodifacoum. The patients who had accidentally ingested superwarfarin or attempted suicide using it were easily diagnosed, while diagnosis was markedly delayed for the 2 patients with Munchausen syndrome. Full reversal of anticoagulation was quickly achieved in the cases of accidental ingestion and attempted suicide. We examined and treated the patients with Munchausen syndrome for months before establishing a diagnosis and fully reversing the anticoagulation. None of the patients in our study died of superwarfarin poisoning.
Superwarfarin exposure or poisoning is a growing public health problem that should be part of the differential diagnosis of patients who present with a coagulopathy consistent with vitamin K deficiency in the absence of coumadin therapy, liver disease, or the use of an inhibitor, and whose conditions do not resolve with large doses of parenteral vitamin K1 therapy.
超级华法林钠暴露或中毒是一个日益严重的公共卫生问题。1988年报告了5133例超级华法林暴露和中毒病例，1995年为13423例。病例可能与意外暴露、自杀未遂或孟乔森综合征有关，且可能难以诊断。
对来自威斯康星州北部有超级华法林暴露或中毒的患者，在威斯康星州农村的一家三级转诊中心进行检查，以确定其暴露原因，并回顾超级华法林中毒的临床表现、诊断、治疗及预防情况。
11例符合超级华法林暴露或中毒标准。研究纳入的7名儿童均意外摄入了超级华法林，2名成年人患有孟乔森综合征，1名青少年和1名成年人曾使用超级华法林自杀未遂。11例中有9例服用了溴敌隆。意外摄入超级华法林或使用其自杀未遂的患者很容易诊断，而2例孟乔森综合征患者的诊断明显延迟。意外摄入和自杀未遂病例的抗凝作用迅速完全逆转。我们对孟乔森综合征患者进行了数月的检查和治疗，才确诊并完全逆转抗凝作用。我们研究中的患者均未死于超级华法林中毒。
超级华法林暴露或中毒是一个日益严重的公共卫生问题，对于那些在没有接受香豆素治疗、肝病或使用抑制剂的情况下出现与维生素K缺乏一致的凝血病，且大剂量肠外维生素K1治疗后病情未缓解的患者，应将其纳入鉴别诊断。
